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Week of 16 April, 1999

Vol. II, No. 31

Health Matters

A family risk: preventing melanoma

A family member of mine was diagnosed recently with melanoma. Does this mean I am at risk of developing skin cancer? If so, what can I do to reduce the possibility?

You are wise to be concerned about developing melanoma, the deadliest form of skin cancer, if a sibling or parent has contracted the disease. In addition to excessive exposure to the sun, a significant risk factor for developing the disease is a family history of malignant melanoma. Affecting 43,000 Americans every year, the cancer results in nearly 7,500 deaths annually and is the leading cause of skin cancer in 25- to 29-year-olds. Six out of seven skin cancer deaths are caused by malignant melanoma.

"If two or more first-degree relatives [parents or siblings] have melanoma, then other family members have an increased risk of developing the disease," says Marie-France Demierre, M.D., director of the Skin Oncology Program at Boston Medical Center and an assistant professor of dermatology at Boston University School of Medicine.

Other risk factors include multiple atypical moles on the skin, a fair complexion (fair skin, blue eyes, and red hair), and excessive exposure to ultraviolet radiation at a young age. In addition, people who have had malignant melanoma before are at risk for developing the disease again.

A cancer that originates from melanocytes, the cells responsible for the color of the skin, melanoma usually occurs in adults, but it may occasionally be found in children and adolescents. If caught early on, the chances of a cure are very high. However, as with other cancers, melanoma can spread to other parts of the body through the lymph system or the blood if discovered too late.

Warning signs, says Demierre, include a change in the size, shape, or color of a mole; oozing or bleeding from a mole; and a change in the sensation of a mole, which may feel itchy, hard, lumpy, swollen, or tender to the touch. It can also appear on the body as a new mole.

The first treatment for melanoma is surgery. Depending on the stage of the disease, additional treatment may include biologic therapy (using the body's immune system to fight the cancer), chemotherapy, or radiation. In advanced disease, a multidisciplinary treatment approach is recommended.

According to Demierre, individuals with a family history of melanoma can and should take certain precautions to lessen their risk. Indeed, she says, everyone should follow these guidelines. "Everyone should practice healthy sun behaviors," she says, including wearing a hat, clothing, and sunglasses to protect exposed areas of the skin; using sunscreen that blocks both ultraviolet A and B rays and has a sun protection factor (SPF) of 15 or greater; and limiting exposure to the sun between 10 a.m. and 3 p.m., when ultraviolet rays are the most dangerous.

While it is hard to keep children out of the sun in the summertime, "awareness and knowledge of the dangers caused by the sun should be a parent's responsibility," says Demierre, especially since severe sunburns during childhood greatly increase the risk of developing melanoma later in life.

"Parents are role models for their children," she says, "and can be especially helpful in teaching them healthy sun behaviors by using sunscreen and making sure their children use it, wearing a hat, and keeping their children out of the sun for prolonged periods of time during the middle of the day."

While the disease can spread to other parts of the body, melanoma is highly curable with early detection and proper treatment. The American Cancer Society reports a five-year survival rate of 87 percent for patients with malignant melanoma. Localized melanomas, which account for 82 percent of all diagnoses of the disease, have a five-year survival rate of 95 percent.

"Health Matters" is written in cooperation with staff members of Boston Medical Center. For more information about melanoma and other skin cancers or other health matters, call 638-6767.